HADM 3000 FINAL EXAM NEWEST

HADM 3000 FINAL EXAM NEWEST
what had the greatest impact on the expansion of hospitals? - once hospitals became
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institutions of medial practice, serving the needs of all members of society and making a
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profit.
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Volume of surgical work, which at that time could be done only in hospitals.
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Congress passing the Hospital survey and construction act of 1946 aka Hill-Burton Act
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Difference between federal hospitals that are public hospitals but why they aren't
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community hospitals - community hospitals- nonfederal, short-stay, services are
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available to the public (85% of hospitals)
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public hospitals- connotes government ownership, hospitals owned by agencies of federal
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state, or local governments(25% of hospitals) more speciality hospitals
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Difference between general hospitals and speciality hospitals - (The difference lies in the
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nature of services rather than the quality)
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General hospitals- provides diagnostic, treatment, and surgical services for patients with a
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variety of acute medical conditions
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Speciality hospitals- admit only certain types of patients or those with specified illnesses
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of conditions; specifically tuberculosis, psychiatric, rehab, children's hospitals.
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II Review information about mental health, where its received and who is more likely to
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II need it - ranks second as a nationwide burden on health and productivity. services are
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II provided by the de facto system which combines specialized services with generalized
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II counseling services. Homeless & women (anxiety, eating, depression). Services II II II II II II II II



II provided in Psychiatric Hospitals (speciality hospitals) II II II II II




II What type of reimbursement method involves a fixed monthly payment- - captation; is
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II used by HMO's under managed care. Under this reimbursement scheme a provider is
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II paid a set monthly fee per enrollee, regardless of whether the enrollee sees the provider
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II or not, and regardless of how often an enrollee sees the provider
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II Discussion of utilization of uninsurance companies, which has the tightest control? - II II II II II II II II II II II II II



II HMO's employ higher utilization controls than other types of managed care plans. The
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II methods most commonly used for utilization monitoring are gatekeeping and utilization
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II review

II Managed care defined - a mechanism of providing health care services in which a single
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II organization takes on the management of financing, insurance, delivery, and payment II II II II II II II II II II




3 Main approaches to monitor and control the utilization of services - 1.expert evaluation
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of which services are medically necessary in a given case
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2. determination of how services can be provided most inexpensively while maintaining
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acceptable standards of quality
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, 3. review of the process of care and changes in the patient's condition to revise the course
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of medical treatment if necessary
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II Gate keeping Method - requires a primary care physician to coordinate all health care
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II services needed by the enrollee. emphasizes preventative care, routine physical
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II examinations, and other primary care services that are delivered by the primary care II II II II II II II II II II II II



II gatekeeper. Secondary care services, such as diagnostic testing, consultation from II II II II II II II II II



II specialists, and admission to a hospital are provided only a referral from the gatekeeper.
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II In this way, the gatekeeper controls access to costly medical services.
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Concurrent, prospective and retrospective utilization - Prospective (before you get there)
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(to prevent unnecessary institutionalization, such as surgery)
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Concurrent (if you go to EAMC, someone will be looking @ chart while you're there) II II II II II II II II II II II II II II



(monitoring the length of inpatient stays/discharging)
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Retrospective (after you leave) II II II




II Medicare managed care option; part C what is it called? - Medicare Advantage, extra
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II benefits such as basic dental and vision benefits, helps with out of pocket costs.
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II Why is long term care special? what is it about long term care that makes it different? -
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II individualized- well coordinated services that promote the max possible independence for II II II II II II II II II II



II people with functional limitations and are provided over an extended period of time in
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II accordance with a holistic approach, while maximizing their quality of life. II II II II II II II II II II




II word for end of life care that is not hospice - palliative care
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Long term care facilities and what is important - not restricted to the elderly; anyone with
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a chronic condition
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- associated with nursing homes, skilled nursing facilities, subacute care facilities,
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specialized care facilities
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II other long term facilities - community based LTC, Home Health Care, Adult Day-Care,
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II Senior Centers, Home-delivered and congregate meals, Handyman services, emergency
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II response systems, retirement facilities, Personal care facilities, skilled nursing facilities,
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II subacute care facilities II II




- 1. community based LTC- a) supplement informal care b) economical least restrictive
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c)temp respite for families d) delay/prevent institutionalization EX. Area AGencies on
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Aging (p.245)
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2.Home health Care- Medicare main single payer for this type (246)
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3.Adult Day Care- community based group program for anything from social, medcal, and
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specialized care(247)
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4.Adult Foster Care- family run home providing care to norelated adults that cant care for
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themselves
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5.Senior Centers- community center for older adults to socialize
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